Provider Demographics
NPI:1679247035
Name:POMIKALA, AUSTIN (RBT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:POMIKALA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S 150 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5435
Mailing Address - Country:US
Mailing Address - Phone:801-554-3820
Mailing Address - Fax:
Practice Address - Street 1:322 S 150 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5435
Practice Address - Country:US
Practice Address - Phone:801-554-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-20-119799106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician